摘要
【目的】探讨急性上消化道出血患者输血时血浆(FFP)与红细胞(RBC)的最佳比例,并评价其预后。【方法】选择2014年6月至2017年6月本院收治的120例急性上消化道出血患者作为研究对象。根据FFP与RBC的输血比例分组,将37例FFP:RBC〉1:1记为A组;将45例FFP:RBC≥1:2,且≤1:1记为B组;将38例FFP:RBC〈1:2记为C组。比较三组FFP和RBC使用量、血常规、凝血功能、电解质指标变化、输血不良反应及预后情况。【结果】三组FFP和RBC使用量对比差异均有统计学意义(P〈0.05),组间对比差异也均有统计学意义(P〈0.05),其中A组FFP使用量最高、B组稍低、C组最低,B组RBC使用量最高、A组稍低、C组最低。输血后三组血常规、凝血功能指标、Ca^2+水平差异均有统计学意义(P〈0.05);组间比较,C组血红蛋白(Hb)、血小板(PLT)、国际标准化比值(INR)明显高于A组和B组(P〈0.05),凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)明显长于A组和B组(P〈0.05),且A组INR明显高于B组(P〈0.05),PT和APTT明显长于B组(P〈0.05),B组Ca^2+水平均明显低于A组和C组(P〈0.05);输血后三组Hb、Ca^2+水平均降低(P〈0.05),A组和C组PLT均降低(P〈0.05),PT和APTT均延长(P〈0.05),INR均升高(P〈0.05)。A组、B组和C组总输血不良反应发生率分别为5.41%、0.00%、2.63%,差异无统计学意义(P〉0.05);三组总不良预后发生率分别为21.62%、2.22%、15.79%,B组明显低于A组和C组(P〈0.05)。【结论】急性上消化道出血患者不同FFP与RBC比例可影响血常规、凝血功能和电解质指标,建议保持FFP:RBC≥1:2,且≤1:1,能够显著减少预后不良事件。
[Objective]To explore optimal proportion of plasma (FFP) and red blood cell (RBC) in patients with acute upper gastrointestinal bleeding and to evaluate the prognosis.[Methods]The clinical data of 120 patients with acute upper gastrointestinal bleeding in our hospital from June 2014 to June 2017 were retrospectively ana- lyzed. According to the proportion of blood transfusion in FFP and RBC, 37 cases of FFP : RBC 〉1 : 1 were re- corded as group A, 45 cases of FFP : RBC more than or equal to 1 : 2, and less than or equal to 1 : 1 were recor- ded as B group, and the other 38 cases of FFP:RBC 〈 1:2 were recorded as group C. The use of FFP and RBC, blood routine, blood coagulation, changes in electrolyte indicators, adverse effects of blood transfusion and prog- nosis were compared. [Results]The differences of the use of FFP and RBC in the 3 groups was statistically signifi- cant ( P 〈 0.05), which were also statistically significant between each two groups ( P〈0.05). The use of FFP in the group A was the highest, the B group was a little lower and the C group was the lowest. The use of RBC in the group B was the highest, the A group was a little lower, and the C group was the lowest. The differences of blood routine, blood coagulation function index and Ca2+ levels among the 3 groups after blood transfusion were statistically significant ( P〈0.05). Compared among the groups, Hb, PLT and INR in group C were significantly higher than those in the group A and the group B (P〈0.05), and the PT and APTT were significantly longer than those of the group A and B ( P 〈0.05), and the INR in the group A was significantly higher than that in the group B ( P〈0.05), and the levels of PT and APTT were significantly longer than those in the group B ( P〈0.05). The level of Ca2+ in the group B was significantly lower than those of the group A and C group ( P〈0.05). After transfusion, the levels of Hb and Ca2+ in the 3 groups were all decreased ( P〈0.05), and the levels of PLT in the group A and C decreased ( P〈0.05), the levels of PT and APTT were prolonged ( P〈0.05), INR in-creased ( P 〈0.05). The incidences of total adverse reactions of blood transfusion in the group A, the group B and the C group were 5.41%, 0.00%, 2.63%, respectively, without statistically significant differences (P〉 0.05). The incidences of total poor prognosis in the 3 groups was 21.62%, 2.22%, 15.79%, respectively, of which the group B was significantly lower than that of the group A and C ( P 〈0.05). [Conclusion]Patients with different FFP and RBC ratios can affect the function of blood clotting and electrolyte of acute upper gastrointestinal bleeding, and it is recommended to maintain FFP:RBC more than or equal to 1:2 and less than or equal to 1 : 1, which can significantly reduce adverse events and improve the prognosis.
作者
黄雅
吴月清
王海宝
HUANG Ya;WU Yue-qing;WANG Hai-bao(Department of Blood Transfusion, Hainan Branch of General Hospital of PLA, Sanya, Hainan 57200)
出处
《医学临床研究》
CAS
2018年第6期1062-1065,共4页
Journal of Clinical Research
关键词
胃肠出血/治疗
血液成分输血/方法
血液凝固
电解质
Gastrointestinal Hemorrhage/TH
Blood Component Transfusion/MT
Blood Coagula-tion
Electrolytes